4. Treatment Plan

Treatment Plan

In the beginning of May, 2003, I went to my new dentist, Dr. F., for a routine cleaning. I described my jaw pain and problems to him, and he quickly explained to me the urgency of getting it treated. Apparently, every time my jaw clicked or popped, it was disarticulating and wearing the bone against bone - which could have been exacerbating any TMJ problems I already had. In fact, depending on the severity of damage to the joint by time treatment is completed, Dr. F. mentioned that I might have to be treated surgically for TMJ as well. Once the pain in my mouth subsided (my trip to the dentist had caused my jaw to lock up so badly, I could barely eat for the rest of the day), I made an appointment with Dr. D., an orthodontist recommended by Dr.
F. When I went to see Dr. D. for the first time, he also agreed that I needed treatment, and briefly described the process that Dr. S. had told me about again. I went back a few weeks later after my molds and X-rays were completed, and he outlined the treatment plan a little more thoroughly.

Dr. D. seemed to think that my time in braces would be at the shorter end of the 6-12 months, both before and after the surgery. However, he pointed out that I still had an overbite, which we were hoping would be corrected with the combination of the braces and surgery bringing my jaw up into alignment. Despite having my bicuspids extracted when I was about 14, which I’m assuming was to correct my overbite, my teeth were still about a tooth and half off from lining up properly. Since Dr. S. had warned me that there was always a chance that my teeth would revert to the way they were before the surgery, I had asked Dr. D. how my tongue thrust would affect my chances. At rest, my tongue naturally goes in between my teeth on the left side, and then it also presses against my upper front teeth, so he recommended going to a speech therapist to correct that. I reluctantly added that to the list of people I had yet to see, but I was still hoping there was another way to deal with it.

Dr. D. had also made up charts that showed the angles of my face. Although I didn’t understand all of the numbers or pictures, he did point out that my lower jaw angle was very steep, and this likely contributed to my jaw asymmetry. Along with the genetic implications, the slightly unusual length of my face coupled with the steep angles caused my jaw to grow more vertically than horizontally, thus causing my jaw to grow apart. Apparently, as the jaw grows and separates, it does so in a counter-clockwise manner, which explains why my jaw had separated on the left side and was skewed to the right. Dr. D. also went over the two courses of treatment with me - I could choose the conservative route, which would entail braces and heavy use of bands on the left side to forcibly pull the teeth together, or the braces/surgery route, which would change the bone structure of my jaw instead of just the teeth. Since I had already undergone the braces/bands treatment, which proved rather temporary, I told him that I was committed to the treatment plan of orthodontics and surgery. He also warned me that although my insurance company would probably eventually approve the orthognathic surgery, it might take a year or two of both me and my oral surgeon writing letters to them to convince them that surgery is necessary. This was the same warning I had also heard from Dr. S., and that I would hear repeated throughout my initial stages of my treatment.